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The National Cancer Institute reports 2017 U.S. cancer care expenditures were $147+ billion, with anticipated increases from our aging population.

According to Deloitte’s report in Evidence Based Oncology ( The American Journal of Managed Care publication), many organizations are exploring ways to control costs and enhance care quality for oncology patients (e.g. Patient Centered Medical Homes, CMS’ Oncology Care Model).

With many different types of cancer and treatment options, each patient embarks on a personal care journey.

Oncology patients often experience a long journey. Although some steps entail engaging with care staff at a hospital or clinic, most of the time patients are challenged with managing their disease on a daily basis away from the health system.

Healthcare organizations need to closely monitor oncology patients to determine when care and support is required. To be proactive and stay aligned with patient needs, health systems must collect patient information (e.g. Patient Reported Outcomes/PROMs, Patient reported experiences/PREMs). This patient information can guide the care team to intervene, reducing hospitalizations and costs.

“A few years ago, we successfully used a patient engagement care tool with our palliative patients. Our palliative team is embedded within Oncology. Eighteenmonths ago, we introduced this telehealth type of application to our oncology patients. We felt it would be valuable to extend TapCloud to our general oncology patients because we had seen such a positive response using it for those with high symptom burden and advance disease. We believe many patients and caregivers will benefit from having this tool available to use”.

Patient Experience

How does TapCloud support the oncology patient? What is the patient experience?

Last month, Robert (not his real name), a 77 year old patient was diagnosed with prostate cancer. Dr. Twaddle and her staff worked closely with Robert through the onboarding process to provide an overview, demonstrate how to use TapCloud, help him download the TapCloud app onto his phone and iPad and discuss what symptoms they will manage to personalize the app for his specific condition.

The Nurse Coordinator explained “Robert, with this tool (TapCloud), we can think about you when you are not in front of us, get a sense of how you are doing and that we are on the same page”. Robert was relieved to get a message from his Nurse Coordinator confirming that she can see Robert listed on the dashboard to keep a close eye on him.

Most of Dr. Twaddle’s seventy active patients using the TapCloud App are in their 60s and 70s, with a few in their 80s and 90s.

Through the TapCloud app Care Plan, patients like Robert are asked a set of questions. How are you feeling today compared with yesterday? Which of these meds are you taking? Which symptoms are you experiencing today? Symptoms that were selected the prior day are displayed bold. Patients can add symptom(s) which typically takes less than a minute to provide this critical information.

Symptom tracking is made easy by using a word cloud. Each day, the patient sees a personalized word cloud containing symptoms. This personalized symptom cloud incorporates his condition and medications and his list is continuously enhanced from machine learning. TapCloud’s predictive symptoms cover 100+ conditions and 14,000+ side effects. The patient simply touches those symptoms he is noticing. Additionally, he views personalized education based on his journey stage (e.g. tips for managing chemo side effects) and what he is experiencing. He can also upload this biometric information (e.g. vitals, etc.).

How has Northwestern Medicine used the TapCloud tool to deliver better care to Oncology Patients?

Dashboard displays demo data only

Prioritize Patient Outreach. The TapCloud platform analyzes all the patient clinical and self- reported data in real time. Using advanced algorithms, patients with a clinical need are identified and alerts are sent to the care team. Patients are prioritized based on alerts, severity and risk. Nurses use theTapCloud Triage Dashboardto efficiently track, monitor and respond to patients requiring an intervention. Nurses can drill down on a specific patient to see how many days since check in, recent events (e.g. vitals, medication usage), pain and anxiety levels.

Intervene on specific symptoms: Instead of “fishing” for information about how a patient is feeling or having the patient end up in the ER, Nurse Terri can call the patient and say “I've noticed that you've had increased pain the past 2 days…”. TapCloud can also be set up to send alerts for symptoms associated with a patient’s treatment. Patients can send a picture within the TapCloud app with a secure message about their concern.

In the Patient’s Words: “We had one patient who didn’t feel pain but entered ‘yuk’. He selected that to communicate in his words what he was feeling. One of the features that I really like is journaling. A patient may share that today he is ‘discouraged by his illness’. Although he does not expect us to respond, it gives us insight into how he is doing and the support that he may need from us”, shares Dr. Twaddle.

Stay Connected with patients who do not come in regularly: When patients are going through infusion treatment, Dr. Twaddle explained that her team sees them on a frequent basis. “However, when our patients are on oral chemo, we feel that TapCloud is especially valuable to give us a window into their experience. We risk losing them because they cannot tolerate the medications and stop without communicating to us.”

Address Patient Needs with Right Resource: When patients are not in the Clinic or Hospital, it is important to understand what they need. “We may see in a patient’s journaling that she is feeling afraid which is not physical but may be best addressed through our psych- social resource. Or a patient may be ‘running out of her medication’ or ‘checking in on an upcoming appointment’, which can be managed by our Nurse Coordinator."

Measuring Success

Dr. Twaddle uses a set of quantitative and qualitative measures to evaluate the success for the TapCloud solution for oncology patients including:

1) Patient Engagement. How involved are patients in participating in their care? How often did they check in with the app? Which symptoms are most common? What are the new symptoms that have been added by the patient?

3) Cost reduction. How much money was saved by avoiding ER through interventions on symptoms? “When one of our cancer patient ends up in the ER, we explain that we may be able to help avoid the admission with a check in on the TapCloud tool. We had one patient with a side effect that we could have spotted and intervened since it was dangerous for her”.

“We have found that TapCloud is helpful both with cancer patients who have declining function (e.g. pancreatic, advanced lung, brain tumor) and with those that may be curable (e.g. head & neck, breast)", shares Dr. Twaddle.

AMITA Health’s Program will leverage TapCloud

AMITA Health, one of Illinois’s largest health systems is in the process of planning their program which will use TapCloud.

“When I first heard about TapCloud, I was on board immediately”, explains Dr. Robert O. Maganini, Breast Cancer Specialist at AMITA Health. “We have a compliance problem with our breast cancer patients. Although the hormone therapy treatment (e.g. Tamoxifen, Class Aromatase inhibitor) is for five years, some patients will stop after two years because of the side effects. Our working theory is if we have insights into where these patients struggle and when, we can do more aggressive interventions instead of waiting for their next appointment”.

“Our plan is to offer TapCloud to all 200 patients who want to use it, from newly diagnosed to those in year two when we experience a drop in treatment adherence”. After describing his patient population – mostly women 40-75 years old, Dr. Maganini expects a high opt- in rate since it is “ideal for them because it enables faster and more convenient access to their provider”.

Like Dr. Twaddle, Dr. Maganini is planning to use a patient- centric approach when introducing TapCloud, ensuring that patients understand why they are using TapCloud, how to use it, and when to use it.

Dr. Maganini plans to introduce TapCloud to patients at the time of diagnosis. Nurses (e.g. NPs, Navigators) will get patients set up and show them how to use the digital health application. “Since surgery is typically the first step, we plan to use as a follow up with discharge instructions. For those in going through chemo treatments, we will monitor their symptoms. We want to get our patients accustomed to using TapCloud and then they will be using it for the long run with hormone therapy”.

As part of the planning process, Dr. Maganini is working with his team to define the list of side effects including the words that these patients use to describe them. He is leveraging his own and his nursing staff’s patient experiences to devise the TapCloud symptom list in “patient speak”. This is helpful to patients who often struggle to describe their symptoms and feelings.

From this program, Dr. Managini expects to learn about the top side effects, interventions and the effectiveness of the interventions. He will be looking at different success factors – “increase in the therapy completion (3, 4, 5 years) and longer term (beyond the 2 years) hopefully a decrease in mortality rate and reoccurrence”.

“With a program showing demonstrative effectiveness, we envision scaling this to the AMITA Health 2.0, 19 hospitals”, concludes Dr. Managini.

It all started with a simple question one day, and grew into a trusted health relationship a few short months later. Sarah was very busy at work that crisp fall morning and had only a few minutes to log in and ask about her daughter’s diabetes medication. Sarah was comforted by the response and a bit intrigued when her Health AssistantHarriet introduced herself and explained that she is a resource to help her and her family with any of her health questions or concerns. They began a conversation about her daughter’s condition and a trusted relationship began.

Later that week Harriet made a follow up call to see if Sarah was able to pick up her daughter’s medication and asked how everything was going. Sarah mentioned that she finally got her daughter’s pills and confided that she was completely overwhelmed. Sarah shared that she was recently diagnosed with breast cancer and that her husband was often unavailable as he traveled constantly for work. She explained that she had a hard time getting to her treatments. After their call, Harriet explored and evaluated resources, and scheduled transportation to help Sarah get to her next appointment. Harriet put the appointment confirmation into Sarah’s patient portal and set up a reminder, including date and time, about the ride to her next treatment.

This may sound like fiction in the current healthcare environment, where services are siloed and patients are burdened with making their own decisions around healthcare – often complex and costly. Sarah is relieved to have this service today. She first learned from her employer about the Accolade platform and health advisor service last summer. It wasn’t until she reached out with a simple question to her health assistant that Sarah experienced the true value of having a healthcare advisor on her side.

A 2016 Harris Poll reveals that 84% of working families placed a value on having a single, trusted resource to help support their healthcare needs. Busy families have limited time and resources so they appreciate having one place to go to help them understand their options and sort through their healthcare decisions.

Personalized Patient Experience

With the Accolade Health Assistant as the single point of contact for her family, Sarah is able to reach out to Harriet for guidance all along her and her family’s healthcare journeys. Accolade integrates high tech and high touch to deliver a superior patient experience with lower healthcare costs.

Accolade Health Assistant Harriet accesses the Accolade platform to interact with and personalize her support for Sarah:

Preferred Communication: Harriet engages with Sarah and her family based on their communication preferences. Sarah likes phone calls and email through the Accolade online portal. Sarah’s husband Sam prefers secure text messages since he can send quick messages and follow up later during his business trips.

Personalized & Proactive Experience: Harriet’s interactions with Sarah are driven byrich patient profile information, which contains contextual information, social determinants of health and service utilization. Sarah and her family’s profiles are updated withdata collected over time andmore than150 data feeds integrated into the Accolade platform. The HIPAA-certified approach creates profiles that are continuously analyzed through sophisticated algorithms and health assistant reviews, which allow for personalized conversations around individual health needs, care gaps and obstacles.

A recent Accolade platform trigger prompts Harriet to reach out to Sarah’s husband Sam when she notices that he is still refilling this pain medication many weeks after his knee surgery. Harriet sent a text to Sam to inquire about his knee surgery. After a text exchange, Harriett suggested that he see his doctor to discuss his persistent pain.

Patient Education & Connected Health: Sarah and her family canaccess educational information andrecommended health apps. Before Sarah’s husband knee operation, Health Assistant Harriet texted Sam with a link to a video and suggested questions to prepare for his surgery and provider discussion.

When Harriett spoke with Sarah about her daughter’s diabetes appointment and care plan, Harriet informed Sarah about the Livongo mobile diabetes application available through her employer’s health plan. Together, they review the Livongo app, which can help Sarah and her daughter better track and manage her diabetes. With Accolade and Livongo, Sarah is able to share information from the mobile app with her daughter’s doctor, giving him insight into her problems with controlling her A1C levels.

Continuous Connection to Clinical Resources and Support: Harriett asked Sarah if she would like to speak with an oncology nurse to help prepare her for her upcoming oncologist appointment. Margaret, an Accolade Clinical Health Assistant and RN, joined them on the line and offered empathetic support by asking more about Sarah’s diagnosis, where she was in her care plan with her doctor, whether she had a support network and what was planned for her next appointment. Margaret provided Sarah with questions to ask her oncologist and recommended a follow-up discussion.

Intelligent Engagement: Harriet and her Health Assistant team are continuously alerted by the Accolade platform. On an ongoing basis Accolade gathers, aggregates and models de-identified data to trigger alerts and guide Health Assistants in further personalizing their interactions with their clients. Health Assistants are prompted to ask questions about health behaviors and emerging symptoms, applying specialized training and skillset.

Patient Experience Success Measures:

Paul Csigi, Director of Benefits at Philadelphia- based Temple University Health System (TUHS), rolled out the Accolade solution in 2015 and has over 7,000 employees on the platform today. “So much of healthcare is getting people to the right place at the right time. Accolade has created an experience where our employees build a relationship with an assistant that gives them what they need, when they need it. Accolade takes a single problem that the patient has called in about and creates a relationship to support the family on an ongoing basis. With all of the information about our employees, Accolade addresses the whole person, connects the patient with clinical resources, and continues to reach out. This helps treat our employees sooner, which is less expensive for our organization.”

In addition to financial measures, TUHS monitors qualitative feedback from employees. With the Accolade platform outreach (phone or online), TUHS is able to capture the patient’s experience engaging with their Accolade Health Assistant:

“I'd like to thank Temple for the Accolade program. We have been going through some really tough times…..my health assistants have been a big support and a big help to my family in helping to guide us to the right doctors to help with family issues and illnesses. I really appreciate this program. Without it, I'd really be lost.”

“It is great having that person who is able to explain things to you and walk you through the process….It makes navigating the current health care world so much easier and less stressful. That is exactly what you need when you are dealing with a health care issue.”

“I spoke with my health assistant and then with the nurse, and they were incredibly helpful. They spent a lot of time on the phone with me, helping me understand how to navigate the system, and what questions to ask.”

“He [Clinical Health Assistant] made this very difficult hospitalization for my husband an easier journey. Without him, I wouldn't have been able to accomplish many things….I am extremely grateful.”

Patient Experience Journey

With two years of the Accolade solution under their belt, Paul Csigi and his team are considering new ways to support TUHS employees. “I have an employee population with diabetes and heart disease. I am interested in learning more about Accolade’s partnerships to bring patient data into the platform to support these populations.” Csigi sees the benefit of bringing in data from patient devices and smart applications. Integrating this data with the patient’s medical record gives new insights to Accolade Health Assistants, empowering them to deliver even better support and drive improved outcomes.

Dartmouth-Hitchcock (D-H), an innovative New England healthcare system with 1,000+ providers is committed to creating a “sustainable health system”, which proactively engages patients through new care models to achieve the triple aim.

Over the years, D-H has invested in technologies that empower patients to collaborate with providers through shared decision tools and Telehealth, treating “patients and their families as partners in care”.

D-H has been a pioneer in innovative payment models with both the government and commercial payers.

In early 2015, D-H’s leadership team committed to create a truly patient-centric healthcare organization, which delivers high quality proactive personalized care to the patient beyond the hospital walls.

“Dartmouth-Hitchcock purposefully set out to assemble a team of employees with backgrounds from other consumer industries like hospitality and retail that would augment the world-class capabilities of our clinical staff, to improve the health care delivery experience”, explains Vin Fusca, COO, ImagineCare.

With their consumer- centric “healthcare without boundaries” vision, D-H management has designed a truly “care- driven” solution. ImagineCare, a cloud- based platform, enables providers to closely collaborate with each patient to meet her care goals at any time and from anywhere.

With ImagineCare, the Provider and patient have a window into the latest health status for insight and action. In the background, ImagineCare collects information from the patient (i.e. sensor- based devices, apps), combines it with EMR data (i.e. patient visits, labs, meds) and processes it through complex clinical care algorithms with machine intelligence to pinpoint when the patient is at risk. High tech meets high touch when ImagineCare notifies the RN or Health Navigator to reach out to the patient for real-time support and intervention.

“ImagineCare leverages the best available technologies to assist with care, but does not replace the importance of the human touch to drive behavior change. ImagineCare seamlessly combines these components to help patients achieve their health goals”, shares Dr. Ethan Berke, Chief Medical Officer, ImagineCare.

Patient Experience

During her recent doctor’s visit, (patient) Pam decides to participate in D-H’s new ImagineCare Program to help her lose weight and proactively manage her hypertension.

Within 48 hours, Pam receives an email to quickly enroll in ImagineCare and a welcome call to discuss her personal health goals. Two days later a personalized ImagineCare Kit (box) is delivered to her door containing a program overview, a wireless blood pressure cuff and an activity band, devices which fit her selected health goals. Pam follows the instructions to connect her devices to the ImagineCare app.

During enrollment, Pam’s shares her profile information such as personal health goals, challenges, communication preferences, family support, and defines her “medical neighborhood” (i.e. Providers, pharmacy, caregivers). She adds more information when responding to daily questions to create a rich picture about her health needs and resources required to tackle care plan activities.

Anxious about her attempts to lose weight, Pam indicates in the mobile app that she only wants to receive texts to help her stay on track with her weight-management goal.

Through the ImagineCare mobile app, Pam answers daily questions about how she is really doing, while her wireless blood pressure cuff and activity band retrieve and send real-time measures. Pam receives nudges, encouraging messages and digital check-ins to ensure she stays on track with her care plan. Yesterday’s text asked Pam if she was okay since she hadn’t provided her blood pressure as expected.

D-H’s RNs and Health Navigators continuously monitor Pam’s health status, review her trends, and respond to risk warnings by reaching out via text which is her communication preference. Since Pam designates her daughter as a personal health representative within the mobile app, ImagineCare’s RNs are permitted to speak with her about Pam’s health.

ImagineCare Success Measurement

ImagineCare is designed to empower a health care organization to right-size provider visits, lower ED utilization and decrease admission and re-admissions. ImagineCare provides a more engaging solution to help health care delivery systems increase quality of care, decrease cost and improve patient experience.

In addition to these quantitative measures, D-H actively gathers qualitative patient feedback to understand the patient experience. Comments from patients about engaging in the ImagineCare program include:

“I monitor my blood pressure every day, and after a particularly stressful day at the office I went home, took my blood pressure, and five minutes later one of the nurses called and talked me through an immediate care protocol.”

“It has improved my ability to manage my health…The ability to connect with people for support and also send information to my healthcare providers, makes it easier.”

"I am extremely impressed with the ImagineCare phone app. It is very easy to use and seems very intuitive”.

ImagineCare Future

ImagineCare is constantly updating its services and products based on patience engagement data, clinical data, and new technological capabilities coming to market. In a digital health landscape that is becoming more fragmented, ImagineCare will continually create holistic, customer-centered health services to better care for patient populations.

D-H’s team has packaged up the ImagineCare platform for other providers, payers and (self- insured) employers to deliver personalized patient care for better outcomes.

Dr. Milani with longtime patient Andres Rubiano, pilots Apple WatchDuring the last eighteen months, the Ochsner Health System has moved into new territory, meeting consumers where they are, from their OBar, a retail genius format to patient hypertension pilots with the Apple Watch to drive behavior change.

As an innovative healthcare organization, Ochsner, a large Louisiana- based health network with 12 hospitals, 40 clinicians and an a 1,000+ Physician Group Practice, is committed to helping consumers use mobile and wearable connected health tools for self- management and care collaboration

It all started back in late 2013 when Dr. Richard Milani, now Chief Clinical Transformation Officer and Vice Chair of Cardiology at Ochsner, observed what was going on nationally, a tremendous growth of mobile phone and smart apps. “At the time, I noticed that a lot of people didn’t know much about the health apps and wearables or were fearful about how to use them. My background is in preventive medicine”, explains Dr. Milani. “I saw a powerful opportunity for Ochsner to empower consumers to use mobile technology to enhance their health, opening the door to favorable behavior change.”

OBar,Retail Genuis Bar with Apps & Devices

After more than nine months of planning, Ochsner launched their OBar in early 2014 at the new Ochsner Center for Primary Care and Wellness. The OBar is located in the lobby to attract people walking by as well as patients. The retail store is welcoming with digital tablets loaded with vetted mobile apps to support consumer health, “non-clinical” genius types to answer questions, provide guidance and sell discounted devices (i.e. Activity Tracker, wireless scale, blood pressure cuff and glucometer). “We created this retail setting to show people how to make themselves healthier on their own, independent of their health system. We also felt that as a health system, we could show you which health apps were good and can help you get the app loaded on your phone to begin using it.”

Doctor gives patient RX for App, directs to OBar Ochsner wanted to go further, tying the OBar into their primary care services. Dr. Milani and his team created a prescription pad for their PCP offices, which lists the types of available apps and devices. The doctor simply checks off, hands the patient a prescription pad sheet and directs him downstairs to the OBar. Since this extension into primary care, clinicians have heard back from their patients about how the apps and devices have helped them make better health choices around activity, diet and their disease. Patient feedback has motivated these clinicians to tell others about the OBar.

Dr. Milani went on to explain that the OBar initiative is not designed to be a profit center. As a non-profit, Ochsner is most interested in helping people stay healthy and has invested in a retail format as a way to be sticky to attract and keep consumers coming back. As with any retail store, visitors walk in and out which makes it challenging to capture and measure the value that consumers have gained from using these apps and devices. Through anecdotes, however, Ochsner has heard about the weight loss, the knowledge about “buying the right foods” and the ability to better “understand my disease”, which has helped many consumers visiting the OBar.

Apple HealthKit & Epic Integration for Connected Health

Ochsner was the first hospital to integrate the Apple HealthKit with their Epic system. This integration powers their Connected Health programs. While the patient is still in the hospital, she is given a tablet to answer a detailed questionnaire. Hypertensive patients, for example, are asked sodium consumption, medication adherence and affordability, social situations, depression, physical activity, BMI, sleep, Health literacy, Patient activation and more. Ochsner believes that patients respond more truthfully to the tablet.

“We are phenotyping patients based on their specific disease and psycho- social measures that are fed into algorithms to personalize the care plan and decision support tools”, Dr. Milani explains. “Ochsner started with Heart Failure in early 2014, with a program for CHF patients to avoid readmissions through weight monitoring. In February 2015, we launched our Hypertension Digital Medicine Program, monitoring blood pressure and heart rate. “With the HealthKit/Epic integration, we are able to use the patient’s unique responses to the survey combined with the monitoring data to tailor the intervention to the individual”, adds Dr. Milani. Ochsner care providers monitor the dashboard to determine which patients are the priority today and to see the task check list for action.

The national data reflects that currently, only 50% of individuals diagnosed with hypertension (high blood pressure) have their blood pressure under control, or at goal. Lack of achieving goal blood pressure means that these individuals have significantly higher rates of stroke, heart disease and kidney failure. Ochsner has enrolled only patients that have failed to meet control blood pressure goals, and using this integrative approach, has achieved more than 60% control rates within 2 months.

Dr. Milani and his team wanted the patient to see his progress in the program and designed an insightful report, which visually displays results and progress, quantifies risk and describes how the patient can reduce that risk. This program report is available in the patient portal and is also mailed monthly to the patient. “We decided to mail the report because we wanted the patient to have the opportunity to share the report with their family and to have the discussion about how they are doing in controlling their blood pressure in order to strengthen every day support”, admits Dr. Milani.

In addition to the program report, program participants receive ongoing mobile texts for motivation and encouragement.

Ochsner closely tracks, monitors and has presented very positive patient outcomes of their Integrated & Connected Health programs. One interesting insight that Dr. Milani has shared is that these participants are more successful in the beginning when they have the OBar support. “A Hypertensive patient can go to our OBar, get the program app downloaded on her phone and a demonstration about how to use the devices. This is especially important with older patients who may not feel comfortable getting set up over the phone. We realize the importance of providing this face to face technology support for our Connected Health program and are adding OBars to our other regions”, confirms Dr. Milani. Ochsner is planning to launch three more retail OBars by the end of the year.

Apple Watch for Patient Pilot

Dr. Milani views the Apple Watch as a behavioral change tool. As a foundation, this is a wearable, with many non-health features which captures the consumer’s attention and motivates consumer engagement. It takes the consumer’s focus off the phone and onto the wrist to communicate time as well as personal and professional messages.

Ochsner is designing a study to understand the potential for changing the consumer’s behavior around health. They will be enrolling hundreds of hypertensive patients with the goal of increasing physician activity and improving medication adherence.

Dr. Milani mentioned two of the health related Apple Watch apps which he plans to incorporate to help patients achieve the pilot goals. “There is a WebMD app which is a great medication reminder. It taps you on your wrist and shows you the picture of the pill that you need to take at that time. This is important because 50% of patients with chronic disease do not take their medications as prescribed. The second built-in app is for physical activity which can be used to set goals. It will tap me and remind me to stand up every 50 minutes. I can also see how I am doing against my activity goals”, shares Dr. Milani.

For the Apple Watch pilot, Ochsner will compare the outcomes and behavior change for patients in their Hypertension Digital Medicine Program with a subset of patients who also have the Apple Watch medication and activity reminders and tracking. Throughout the pilot, Dr. Milani and his team will be closely monitoring whether and how these apps impact positive patient behavior change.

Healthcare reform has placed increased demands on doctors who are already managing increased patient loads. As a result, doctors are spending less time with their patients.

Patients are being asked to take on more responsibility in managing their care. This is particularly challenging before and after a surgical procedure. A patient typically leaves the hospital with a stack of paper discharge instructions about medications, the follow- up visit and a list of symptoms to monitor with directions to contact the doctor if problems occur. Throughout recovery, the patient is often left to figure things out because she "doesn’t want to bother the doctor". When the patient makes uninformed decisions about medications or readiness to begin an activity level, it can set her back on her recovery path or lead to costly hospital readmissions.

Other than checking in with patients during the follow- up visit, providers are in reactive mode; patients calling with complex problems or heading to the ER.

Since patient satisfaction, care quality and costs are impacted by the current process, providers are motivated to find a solution that virtually supports the patient's needs for guidance, education and shared decision making.

Virtual Patient Support

It all started in 2007 when Dr. Jordan Shlain was treating a patient who wasn’t feeling well. After discussing her symptoms, he gave the patient his cell number and asked to please call him if she felt worse by morning. He discovered a few days later that she had developed pneumonia. From this experience, Dr. Shlain learned that although he wanted to be proactive with his care, he couldn’t depend on the patient to call with an update. His began texting patients asking “do you feel the same, better or worse?” Dr. Shlain did not take any chances and assumed that a non- response from the patient indicated there may be a problem.

After speaking with providers about not really knowing how a patient is doing post discharge, they expressed interest in daily virtual interactions with the patient as a way to increase patient engagement and prevent readmissions. Patients loved the idea of interacting electronically with their doctor on a daily basis since it would give them unprecedented access to communicate concerns and address problems in a quick and convenient way. This was the backdrop that led to the development of Healthloop.

“Since late June, we have been using Healthloop for patients who have hip and knee replacement surgery”, shares Dr. Mohan, Surgeon for a large Integrated Delivery Network. “Our team was looking for a solution that would enable us to share the experience together with our patient. We also wanted to put the patient in the driver’s seat and give them control, while we were in the passenger seat as an observer and navigator.” Dr. Mohan’s orthopedic patients are on Healthloop before surgery and throughout recovery which tends to be 1-3 months.

Dr. Andrew Goldstone, ENT Surgeon at Greater Baltimore Medical Center started using Healthloop in February with his adult and pediatric patients throughout recovery which typically lasts 2-4 weeks. Healthloop electronic communications are delivered to the parents of his young patients for ongoing support. "HealthLoop, in a technologically modern way, tries to mimic the old days when we admitted patients a day or so before and kept them as many days as we or they wanted to stay after surgery. This gave patients and their families a comfort level that most current M.D.s have never witnessed. The same goes with patients who, after ambulatory surgery, pay at the next window and go home. They have no clue how patient friendly it used to be having an extended ’hand holding‘ before returning home. I view HealthLoop as an attempt to recreate that extended comfort,” explains Dr. Goldstone.

Patient Experience

HealthLoop enables the physician to support the patient before surgery and monitor him post discharge and between visits, engaging each patient “as if he is the most important person”. With the goal of delivering guidance when the patient needs it, Healthloop works closely with the provider organization to define the questions that patients ask at each step of the recovery process. Together, they review typical calls at day 1, 2, etc., determine the appropriate response and set up the schedule to deliver the information to the patient right when they need it.

Taking a closer look at the patient experience, Gary is referred by his primary care physician to a specialist about knee surgery. After deciding together to move forward with the operation, the surgeon quickly enrolls Gary in Healthloop to guide him before and after the surgery. Gary receives an email to complete his enrollment including his preferences for receiving Healthloop communications (i.e. email, text).

Before surgery, Gary answers questions about risk factors and receives guidance and checklists to prepare for his operation. For example, he learns how to to prepare his house to easily navigate when he returns home following surgery.

After surgery, Gary receives a daily electronic communication with a set of questions to understand how he is feeling (i.e. pain level, specific symptoms, problems with meds, etc.), personalized education materials, activity and medication reminders and a checklist of To Dos. Based on Gary’s feedback and progress, his care plan is updated and his next day’s check-in is automatically prepared.

Healthloop is designed for two way engagement. If Gary experiences any health problems, these are gathered through his check- in responses and trigger an SMS message to his care team for intervention and support.

With recent integration to Apple’s Healthkit, patient information is extended beyond daily check- in responses to include health tracking data. For example, Gary’s doctor has instructed him to take steps while healing from his knee operation. Gary’s tracker information is combined with his daily check-ins to give his care team more insight into his health status. Concerned about not enough movement, his clinician may call and learn that Gary is not moving enough because of his medication side effects which can be addressed through a prescription change.

Pilot Feedback; Patients & Providers

Healthloop wants to deliver a truly patient- centric communication channel and uses patient feedback to enhance the solution. After hearing a patient comment that the messages felt “too robotic” and “do not sound like they are coming from my doctor”, the communications were refined to be more conversational.

Another patient commented that the messages were using doctor’s words which resulted in changes to incorporate more patient vocabulary and experience. For example, questions about a blood clot were replaced with “feels like a cramp in my calf”.

Patient Comments

Healthloop has delivered over 57,000 daily check-ins to patients and has received positive feedback about the experience:

Guidance: “I wanted to be able to say ‘I have this” and have someone come back and say that is normal and here is the process. Then all of my negative energy goes away”, “easy way for me to make sure that I was on the track with my recovery”. “The questions promoted me to be more aware of my situation”.

Convenience: “Without Healthloop. I would have called (doctor) 5- 7 times”, “This saved me a trip to my doctor”.

Access: “It was an extension of my doctor so instead of talking to a nurse and having her get back to me, I had a direct conduit to my doctor.”

Provider Comments

Healthloop Clinician Dashboard

“As our team developed our Healthloop, we charted out what a recovery really is. With this, I know what my patient is going through, can emphasize and say with confidence that over half of my patients have their pain under control after day 4”, explains Dr. Mohan. “We also participate in a Medical Destination Program with patients traveling to our hospital, often from out of state. After staying in a hotel for 10- 14 days, they come to see me for a follow-up visit before returning home. We are now thinking about how we can use Healthloop to manage their care from a distance to make sure that the patient has a successful recovery.”

Comments from other providers:

Patient Satisfaction: “My patients told me that they looked forward to their daily Healthloop check-ins because it felt like ‘someone was watching over me’ who really cared”.

Operational Efficiency: “For my practice, the volume of calls from patients has dropped tremendously. I notice it and my staff notices it too.” “I am thinking about eliminating the 2 week follow-up visit and to just see the patient at the 6 week visit since I can check in on their pain management, incision and any other issues through Healthloop.”

Better Quality: “Helps us pick up complications much sooner. It reinforces a plan with what to do and reminders”, “We are raising the bar on care by ensuring that we are giving the patient the pre and post-surgery education and care that they need”.

Success Measures

Providers using Healthloop are evaluating a set of success factors based on their program goals. In addition to lower costs which is measured over time, providers are monitoring:

Regarding patient engagement, some providers are leveraging positive ratings through social media. Patients who give the highest scores (5 Star Ratings) are encouraged to share their ratings and experiences through the link provided to public review sites such as HealthGrades and Vitals. Patients who give average or below average score are asked to explain how the provider can improve. Patients have commented on everything from old waiting room magazines to being put on hold for too long when they call.

With Healthloop, “my patients tell me that they are happy with the surgery because I was right there with them. I also notice patients are much more relaxed during their follow-up appointments. That is so important to me”, Dr. Mohan concludes.